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We use the metaphor of ‘warp and weft’ to represent the ‘fabric’ of MBPs. In weaving, the warp is theterm for the fixed thread that runs vertically through the cloth, while the weft is the term for the transversethread that makes each tapestry unique. The warp is the thread that is fixed when the loom is set up, while theweft varies in texture and color. The essential, constant and integral threads that define an MBP regardless ofpopulation or context make up the ‘warp’; they are what make it a mindfulness-based program. Each adaptedMBP then introduces a unique ‘weft’ that seeks to target the training to a particular population and/orcontext. Within each aspect (program and teacher) we examine what is warp (i.e., essential to an MBP), andwhat is weft (i.e., will vary depending on context and/or population) (Table 1). The warp elements of theframework are anchored within the program forms of MBSR and MBCT. We suggest that the framework weoffer can provide some unifying clarity for the wider MBP field on what an MBP is and is not.The Essential (‘Warp’) Elements of Mindfulness-Based ProgramsThe MBP program1.Is informed by theories and practices that draw from a confluence of contemplative traditions, science,and the major disciplines of medicine, psychology and educationThe key influences that have shaped MBPs are:Contemplative mindfulness practices: MBPs are underpinned by theories about the human mind-body drawnfrom aspects of early Buddhist psychology, which articulate the ways in which people can come to recognizeuniversal habitual psychological patterns that create and maintain distress. This philosophy and psychology isnuanced and complex. It includes a wide array of teachings and practices found across the breadth of bothBuddhist and other traditions, which are beyond the scope of this paper (Williams & Kabat-Zinn, 2013).However, there is high level consensus on common features found within the cultivation of mindfulness. Theseinclude that people can learn that habitual reactive patterns stem from unhelpful habits of the mind; that fear,denial and discrepancy-based thinking create and exacerbate distress; and that skillful ways of relating toexperience can be developed through awareness, wise discernment and practice which offer the potential for(moments of) freedom from reactivity (Gethin, 1998).MBPs address some universal features of human experience using mindfulness practices as a vehiclefor a systematic training of the mind in the service of developing greater awareness of self and others, and5

thus, greater understanding. It is therefore not surprising that mindfulness practices can be found in many ofthe world’s contemplative wisdom traditions. MBPs draw on aspects of these traditions whilst leaving behindtheir religious, esoteric and mystical elements. Crucially they are presented in an invitational way, askingpeople to use the mindfulness practices in whatever way best supports their aims and aspirations. Thepractices and frameworks employed within MBPs are thus re-contextualized for implementation withinmainstream settings by ensuring that they are delivered in inclusive and culturally appropriate ways.Science: The development of MBPs is grounded in developments in theory, cognitive neuroscience (Tang,Holzel, & Posner, 2015), translational research (Meadows et al., 2014; Strauman & Merrill, 2004) andevidence-based practice across a range of disciplines. Empirical evidence informs the theoretical modelsunderpinning MBP’s aims and innovations, and continues to refine understanding of what works best, at whattime, for which group of participants (Davidson, 2016).Medicine: MBSR, the original MBP, was developed within a medical framework and culture, as a form ofparticipatory medicine in which patients are challenged to discover and draw upon their own resources forlearning, healing, and transformation (Kabat‐Zinn, 2003).Psychology: MBPs were introduced and incorporated into the field of psychology through the development ofMBCT (Segal, Williams, & Teasdale, 2013). Psychological theory and research now guides the development ofmany MBPs (Dimidjian & Segal, 2015). Indeed, the field of cognitive science has to a large extent taken overthe detailed work of investigating the precise mechanisms by which MBPs alleviate distress and enableflourishing. The process involves mapping theories and empirical understanding across a range of disciplines.Education: The pedagogical processes employed in MBPs draw on educational principles that are experiential,interactive, participatory, student–centred and relationship-centred (Santorelli, 2000).2.Is underpinned by a model of human experience which addresses the causes of human distress and thepathways to relieving it6

The confluence described in the previous section is supported by a model of distress that appliesacross MBPs that explains certain facets of how human distress is created and maintained, and howmindfulness training deals with these maintaining factors, and thus alleviates distress and supports mentalhealth and well-being e.g. (Kabat-Zinn, 2013; Segal et al., 2013). It draws on aspects of cognitive science (e.g.,attention and executive control and decentering (Barnard & Teasdale, 1991)) and trans-diagnostic work (e.g.repetitive thought and experiential avoidance (Dudley, Kuyken, & Padesky, 2011)). This emerging model isbeing clarified and developed as empirical understanding is built (e.g. Brewer, Elwafi, & Davis, 2013; Chiesa,Serretti, & Jakobsen, 2013; Gu, Strauss, Bonda, & Cavanagh, 2015; van der Velden et al., 2015). The field isyoung and emergent, and the underpinning frameworks are the subject of debate and empirical investigation.3.Develops a new relationship with experience characterized by present moment focus, decentering, andan approach orientationAn underpinning premise of the MBP model is the understanding that how people relate and respondto various forms of distress (rather than the distress itself) lies at the core of many problems and disorders. Itis this that determines both the capacity and the extent to which distress can be relieved and transformed. Thetraining aims to enable participants to recognize habitual, conditioned modes of reacting and make a radicalshift in their relationship to their thoughts, feelings and body sensations, as well as to outer circumstances. Theshift in relationship is based on what is called decentering (Segal et al., 2013) or re-perceiving (Shapiro,Carlson, Astin, & Freedman, 2006), in which the MBP participant is trained to attend to thoughts and feelingsas mental events by noticing how they come and go in the mind and how each has consequences in the verynext moment. For example, a person who is rushing to a meeting, might come to realize that in addition to thestress of being late they are compounding the stress by the thought ‘if I’m late everybody will think I am notcoping’. Whereas in an approach such as cognitive therapy, a person might be taught to challenge such athought, in MBPs the emphasis is on seeing it as a mental event, noticing its effects on the body, and the way itcreates further feelings and thoughts that were not part of the original situation. Gradually people come to seethat their thoughts are not necessarily valid representations of reality.4.Supports the development of greater attentional, emotional and behavioral self-regulation, as well aspositive qualities such as compassion, wisdom, equanimity.7

Attentional training within MBPs offers a foundation for the attitudinal dimensions of mindfulness toemerge. MBPs seek to support the ability to meet experience with curiosity, equanimity and compassion(Feldman & Kuyken, 2011). An experiential understanding develops that pain is an inherent part of humanexperience and is ever changing. An orientation of mind characterized by curiosity, patience and equanimitysupports the development of compassion and wisdom. There is an intention to cultivate an internal climate offriendliness towards experience – whether it be pleasant or unpleasant. This supports a shift away fromhabitually battling with experience. MBPs also aim to cultivate positive qualities such as joy, and the ability torecognize and savour nourishing and pleasant experiences.5.Engages the participant in a sustained intensive training in mindfulness meditation practice, in anexperiential inquiry-based learning process, and in exercises to develop insight and understanding.Direct experiential, systematic and intensive engagement in formal and informal mindfulnessmeditation practices is foundational to teaching/learning in MBPs. The training develops familiarity with andunderstanding of the mind and body, and appreciation that attention can be regulated, fine-tuned, andoptimized through training. Rather like physical training regimes, the training progresses developmentally andsequentially throughout the program.The integrity and fidelity of each MBP is maintained by ensuring that all the curriculum elements forthe particular program are included as intended (adherence) and that curriculum elements are not addedwhich do not belong to the particular program form (differentiation) (Crane et al., 2013). It is critical that thecurriculum employed and the particular MBP title match each other. If there is divergence from an establishedcurriculum, teaching structure or process then a new title for the adaptation should be employed, andresearch should clearly identify the adapted curriculum guide used and if any checks on fidelity and adherencewere employed.Adherence to program form is supported by protocols for each MBP (e.g. see Blacker, Meleo-Meyer,Kabat-Zinn, Koerbel, & Santorelli, 2015; Stahl & Goldstein, 2010, for MBSR curriculum guides, and Segal et al.,2013, for the MBCT curriculum guide). Other MBPs have published guides which specify their particularcurriculum adaptations. MBP curriculums vary in terms of number and duration of sessions and timecommitments for home practice. For example, MBSR is scheduled over eight weekly sessions lasting 2.5hourswith 45 minutes of guided mindfulness meditation home practice per day. MBCT is the same but with 2 hour8

long sessions. There is not scope to fully list the curriculum elements and therapeutic techniques which, ifincluded, would be regarded as outside the model for a particular first generation MBP (the differentiationaspect of program integrity). However, examples include: thought challenging and collecting evidence for andagainst the truth for thoughts (which is part of cognitive therapy); an orientation of problem solving or fixing;different sorts of meditation practices (e.g. mantra meditation); talking about the detailed history ofparticipants; and an emphasis on relaxation training.MBPs typically include mindfulness training via three formal mindfulness meditation practices – thebody scan, mindful movement and sitting meditation. Practices are assigned as daily home practice with thesupport of recorded guidance. Throughout the program participants are also encouraged to generalize throughinformal practice by bringing awareness in particular ways to everyday activities.MBPs include learning experiences built around the formal mindfulness meditation training. Theseinclude engaging in an individual and collective investigative inquiry to develop skills in recognizing directexperiences (i.e. thoughts, emotions and sensations), patterns of relating to experience, and the widerimplications of the understandings that emerge. This externalized teacher- led interactional process in classbecomes a representation of the work that the MBP participants begin to engage in within themselves,whereby the investigative process becomes ‘internalized’. Foci for inquiry include participants’ directexperience of meditation practices, and exploration of pleasant and unpleasant experiences which hasimplications for recognizing established patterns of reactivity and the possibility of responding differently. Thefocus will depend on the context/population, but MBPs particularly investigate the territory of difficult,unwanted experiences – stress, depression, physical pain, etc. Participants are invited to explore ‘How am Iexperiencing and relating to these difficulties physically, emotionally and psychologically? What possibilitiesare there for stepping out of habitual aversive reactive patterns into responding with greater awareness andagency?’ Each MBP employs particular exercises to facilitate these investigations.The Teacher1.Has particular competencies which enable the effective delivery of the MBPMBP teachers have particular ‘explicit’ or ‘visible’ teaching competencies. These competencies aredescribed and can be assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria(MBI:TAC), which has shown promising evidence as a reliable and valid tool (Crane et al., 2012; Crane et al.,9

2013; Crane, Soulsby, Kuyken, Williams, & Eames, 2016). The six teaching competence domains within theMBI:TAC are coverage, pacing and organization of the session curriculum; specific interpersonal relationalskills; skilful guiding of formal mindfulness meditation practices; specific methodologies for conveying thecourse themes through interactive inquiry, group dialogue and didactic teaching; and effective holding of thegroup teaching/learning environment. These require particular tailored training experiences to develop (Crane,Kuyken, Hastings, Rothwell, & Williams, 2010).2.Has the capacity to embody the qualities and attitudes of mindfulness within the process of theteachingMBP teachers have in common a sustained commitment to cultivating mindfulness through regulardaily formal and informal mindfulness practices in everyday life. The way in which mindfulness practicemanifests in the life of the teacher and is tangibly sensed in the MBP classroom is termed ‘embodiment’. Thetheoretical model hypothesising how MBP training has its effects includes embodiment as a critical factor inenabling participants to move towards experiential (rather than conceptual) knowing of mindfulness (Teasdaleet al., 2002). Embodiment is a natural outcome of the teacher’s intention to mindfully inhabit their experiencein everyday life and in the MBP classroom, to whatever degree possible in any given moment. It is neither astriving for a particular state, nor a contrivance to artificially fabricate a particular persona, mask orappearance. Through their own personal mindfulness practice, teachers naturally come to inhabit the qualitiesassociated with mindfulness (i.e. non-striving, non-judging, allowing), and the understandings and ethicsunderpinning the practices. The embodied practice element of ethics within MBPs are thus emergent andcultivated through the practice rather than being mandated. The practice of mindfulness enables theparticipant to try out the possibility of eliciting kindness, openness, and patience toward immediateexperience, whether the experience is perceived as pleasant, unpleasant, or neutral (Grossman, 2015). MBPteacher training aims to cultivate the capacity in teachers to communicate mindfulness through the process asmuch as through the content of the teaching, by integrating training in formal and informal mindfulnesspractices into the other aspects of the teacher education and training curriculum.3.Has engaged in appropriate training and commits to on-going good practice10

MBP teachers have by necessity engaged in appropriate education and training to build and deepentheir teaching competence (Crane et al., 2010; Crane et al., 2012; Kabat-Zinn et al., 2011; Marx, Strauss, &Williamson, 2015). Training involves foundational experiential engagement with mindfulness practice and withthe particular MBP curriculum the teacher training is embedded within, preliminary teacher training to buildcore skills, knowledge and attitudes, and then further training to enable the practitioner to reach the thresholdof competence. Within some training programmes, the training journey culminates in an assessment ofteaching competence using the MBI:TAC (Crane et al., 2016), conducted by trainers who have been trained toreliably use the tool.Teachers then commit to on-going good professional practice in line with consensually agreed goodpractice standards and guidelines (Evans et al., 2014; Santorelli, 2014; UK Network for Mindfulness-BasedTeacher Training Organisations, 2012). Two key elements of good practice are supervision (Evans et al., 2014),and ongoing engagement with a personal mindfulness practice including periodic periods of intensivemindfulness practice in a residential setting. As the work of first generation MBPs is becoming moreestablished in the mainstream, more opportunities are opening up for residential mindfulness intensiveswithin a thoroughly mainstream context (e.g. Mindfulness Network CIC, 2016).In the UK there is a national listing of MBP teachers who have undertaken training to minimum goodpractice level, and are adhering to ongoing good practice (UK Network for Mindfulness-Based Teacher TrainingOrganisations, 2016). In the USA there is an MBSR Registry for certified teachers (Centre for Mindfulness inMedicine Health Care and Society, 2016). The organisation of governance within this emerging field to supportthe general public to access well prepared and qualified MBP teachers is underway.MBP teachers operate within professional ethical codes anchored within their root profession (i.e.medicine, clinical psychology, teaching etc) (Baer, 2015), and appropriate to the ethos and ethics of themainstream public institution within which they are implementing (Crane, 2016).4.Is part of a participatory learning process with their students, clients or patientsDelivery of MBPs is usually in a group context which supports perspective taking and the transitionfrom personal story into investigation of common pathways which lead to distress. MBP teachers embedthemselves within this investigation. They are in a particular form of relationship with their participants which11

is underpinned by recognition of our ‘common humanity’ (shared human experience) (Neff, 2011), and thusthe mutual nature of the learning process (Santorelli, 2000).Integration of Tailored Elements into Adapted Mindfulness-Meditation Based ProgramsAs the field has developed, new MBPs have woven in a weft that aims to make the mindfulnessframework and practices more accessible and useful for particular populations and in varying contexts.However it remains an empirical question for each new adaptation whether it improves the accessibility andusefulness of MBPs, and each adaptation needs to commit to building its own evidence base.Adaptations are typically of three kinds:1.Adaptations informed by theoretical frameworks or models that are particular to a new population orsetting. For example, MBCT for recurrent depression is oriented around a cognitive model ofdepressive relapse and how mindfulness can free the mind from engrained patterns of depressiverumination (Teasdale & Chaskalson, 2011).2.Adaptations to the program that make it more accessible, acceptable and potent for a population. Forexample, Mindfulness-Based Eating Awareness Training employs mindful eating practices (Kristeller etal., 2012); mindful parenting programs use parenting activities and examples (Bogels, Lehtonen, &Restifo, 2010).3.Adaptations to the program that embed MBPs in a particular context or setting. For example, MBSR isan outpatient program that can be offered in hospital outpatient settings; mindfulness in schoolsprograms (Kuyken et al., 2013) are adapted for delivery within school curricula; and mindfulness inorganizations (Chaskalson, 201

Jon Kabat-Zinn, University of Massachusetts . Saki Santorelli, University of Massachusetts . J. Mark G. Williams, University of Oxford . Willem Kuyken, University of Oxford . Keywords: Mindfulness-Based Program, Mindfulness-Based Stress Reduction, Mindfulnes